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Adel Ebraheem, Akihito Uji, Muneeswar Gupta Nittala, Srinivas R Sadda; Relationship Between the Cilioretinal Artery and Subretinal Fluid in Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2348.
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Patients with neovascular AMD (NVAMD) can demonstrate varying amounts of subretinal fluid (SRF) at the time of diagnosis, and factors effecting the extend of exudation have not been well established. A cilioretinal artery (CRA) is present in approximately 20% of the population (20.7% of eyes), and could potentially affect the hemodynamics of flow available to the choroidal circulation supplying most choroidal neovascular membranes (CNV). In this study, we evaluate the relationship between the CRA and extent of subretinal fluid.
We identified 212 consecutive patients with treatment-naïve neovascular AMD in at least one eye from anonymized datasets available at the Doheny Image Reading Center (only one study eye selected for each subject). The color fundus photos and fluorescein angiograms of the study eye were reviewed to identify eyes with a CRA (cases group) and eyes without (controls group). Spectral domain OCT data (Cirrus OCT) were evaluated in a masked fashion by 2 graders to identify the presence and volume of SRF. In addition, we also evaluated for other candidate OCT features which could affect SRF such as the presence of subretinal hyper-reflective material (SHRM), cystoid macular edema (CME), pigment epithelial detachment (PED), and the subtype of choroidal neovascularization (CNV). Non-parametric Mann-Whitney test, univariate, and multivariate analyses were performed to evaluate for any significanct differences between cases and controls, and to evaluate the relationship between these factors and the dependent variable, SRF volume.
Among the 212 study eyes, there were 44 cases and 168 controls. The mean SRF was significantly lower in cases when compared to controls (0.72 ± 0.90 vs.1.60 ± 2.36 mm3, p = 0.026). Univariate regression analysis showed a significant but weak correlation between SRF and CRA (r -0.15, p = 0.03); and various OCT parameters including SHRM (r = 0.16, p = 0.023), Cystoid spaces (r = 0.20, p = 0.0004), and Type2 CNV (r = 0.16, p = 0.02). Multivariate analysis demonstrated that the presence of a cilioretinal artery (r = 0.17, p = 0.02) independently correlated with presence of SRF.
In this analysis, the presence of a cilioretinal artery appeared to correlate with the presence of subretinal fluid in eyes with NVAMD. This is may be due to a hemodynamic effect of the CRA which warrants further investigation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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